July 3, 2012

After the Supreme Court decision accepting the individual mandate provision of Obamacare by regarding the penalty for not buying insurance as a tax, Nancy Pelosi said:

Who is the penalty on? The penalty is on people who have the wherewithal but refuse to buy health insurance, figuring they won't be sick, and if they do, other people will have to cover it. So these free riders, as they were identified by Governor Romney himself, he said, people have the ability to pay and can't expect to be free riders, and I think that he termed it exactly right. These free riders make health insurance for those who are taking responsibility more expensive. Personal responsibility is a principle of our country. Conservatives claim it. Progressives claim it. Liberals claim it. We all claim it.

So she's using the conservative rhetoric of responsibility. People who don't buy insurance and then take advantage of the healthcare system have been free riders, and it's this free-rider behavior that identifies them as the targets of the new tax. Rush says this is a big "attitude shift" for Democrats. When getting the bill passed, the Democrats mostly called upon us to feel sympathy for people who lacked insurance and to want to help them — a typical liberal theme. They rarely portrayed the uninsured as people who deserved our negative judgment for taking and not contributing — which would sound more conservative.

The entire mission of the Democrat Party is to create more and more free riders. Haven't they seen to it that almost half the country doesn't pay income tax, a bunch of free riders?

Isn't their goal to get more and more people dependent on the government? Didn't they spend millions advertising for more people to take free handouts from the government? Isn't there a big advertising campaign on right now to expand the scope of food stamps to the food free riders? Hell's bells, folks, the Democrat Party is the free rider party....

Okay. Hell's bells. Whatever. But if this is one instance of holding people responsible — something you support — why not be pleased about it?

Now all of a sudden, according to Pelosi, if you don't have health insurance, why, you're gaming the system, why, you're probably cheating on food stamps, too. Look at the 180 they've been forced to do because they cannot admit that this is a tax. You know, the uninsured are now scum. Free-riding scum.

Cannot admit that this is a tax? They don't like calling it a tax, but Pelosi's explanation fits the problem she's confronted with, which is: Now that the Supreme Court has called it a tax, what will you say to people who are outraged that middle-class people are getting a big new tax? Her answer is: They deserve to be singled out for taxation, because they are free riders.

ADDED: Now, you might say, Rush is acting irritated because he must go on and on rejecting everything the Democratic Party says, because that's the way to achieve conservative goals. I know that's what he does. But it's not the only way to achieve conservative goals. For example, you could say, it's great that Nancy Pelosi finally acknowledges the problem of free riders. Obamacare was sold on different propaganda, but let's recognize that was propaganda and that the free rider problem is real. Let's insist on looking at those other programs and portraying them in economically realistic terms. Let's not let the Democrats bully us with demands that we care about people, and let's be sophisticated about the incentive structures in these various programs.

“Yeah, we said, ‘Look, if people can afford to buy it, either buy the insurance or pay your own way,’ ” Mr. Romney said during a January 2008 debate in New Hampshire. “Don’t be free riders and pass the cost of health care on to everybody else.”

In an opinion article in USA Today in 2009, Mr. Romney again used the term “free riders,” writing that a penalty like that in his health care plan “encourages ‘free riders’ to take responsibility for themselves rather than pass their medical cost on to others.”

What Pelosi said sounded conservative because it is the way the conservative Mitt Romney defended his own plan at the state level. Remember, the Supreme Court case was about whether Congress had an enumerated power that would allow this requirement to buy insurance to be done from the federal level of government.

But if this is one instance of holding people responsible — something you support — why not be pleased about it?

You know what would constitute holding people responsible for their use of ERs? Repealing the Emergency Medical Treatment Act. Setting up a bogus "penalty" that--as was critical to Roberts's exercise in sophistry--still makes it financially savvy to defer buying insurance until you get sick--is a few light-years away from "holding people responsible".

"But if this is one instance of holding people responsible — something you support — why not be pleased about it?"

Because it's a lie. She's using the language of responsibility, but she isn't pushing it. The program is created and marketed to force one group to pay for others consumption. Pelosi's wrapping three percent of the issue behind responsibility and pretending the rest doesn't exist.

Nobody cares what the Democrats said way back when. Nobody recognizes, save Rush, a campaign to increase the rolls of "free riders".

And Governor Romney said that. Said, sealed, delivered-- and you have no chance, Republicans, because you put forth the figurehead of Romneycare, which is so very similar to Obamacare, and thereby fell into the Democrat's trap.

I agree with Althouse-- Pelosi is simply right... she is correct! Anyone in opposition who dare complain now will lose, and lose badly...

Yes, it's a tax, but it's not just the "penalty" part that is the tax, the whole mandate is a tax on everybody who works to pay for insurance to cover all the free riders who don't work. Just because Congress cut out the middleman in their transfer payment scheme doesn't make it any less of a tax-and-spend deal to shovel money from the middle class to the welfare class.

But if this is one instance of holding people responsible — something you support — why not be pleased about it?

Holding people responsible is one thing. Make your kids breakfast at home instead of using the "free" breakfast at school, for example. If you don't have health insurance, you should pay for the cost of your health care, for another. Those are ways people should be held responsible.

Holding people responsible does not mean: You must buy Captain Crunch cereal so you can feed your kids breakfast. It does not mean that all grocery stores must carry Captain Crunch. It does not mean that grapefruit is not allowed to be purchased for breakfast.

The right answer is to return charity to the people. While I'm an atheist, I donated to a church because they had 2000 dental chairs out there, dentists, all kinds of volunteers to take care of people.

That's the way it should be. Not "Well, we want to be in control of compassion, so we are going to take it over by forcing people to pony up for OUR version of compassion, and even borrow money from your kids for OUR version of compassion, and then when people don't want to follow our rules, we will force them."

Liberty is much more important. Plus which, the US Federal government, despite what leftists think, is the LARGEST monopoly on the planet. And with it comes all the crazy inefficiency, lack of paying attention to market demands, all in pursuit of what the monopoly wants. It's the wrong way.

The true cost of the mandate to the average person who does work and has taken responsiblity for himself by having health insurance is the higher premiums he will pay as a result of the bill.

The mandate and "tax" will have a gazillion loopholes so freeloaders will still continue to freeload. Meanwhile, the new minimum coverages will escalate the cost to honest, hard-working folk. (i.e. The Suckers Tax)

I question the "free rider" meme. They just can't admit there are plenty of people who go without insurance, avoid doctors, and do fine. Or used to, before all the obesity and ridiculous pharma-fostered "diseases."

I went without for many years myself and just paid cash at walk-in clinics. My brother went without for about 15 years when his tech company laid him off at age 50. He made it to Medicare. Yes we were lucky. Why should people be taxed for that? I know others, who just lived their lives until they died and didn't sweat the insurance the way everyone does now.

Oh, but Obamacare needs our money, for support of the true free riders.

I don’t buy the “free rider” argument. There are problems to be sure with people who don’t pay their bills (including medical bills) but by and large it has been the States Attorneys Generals who have gone after the debt collectors or the hospitals who treated them for daring to suggest that they should actually be paid for the services that they provided. If you want to go after “free riders,” make it easier for lenders to seize the assets of the “free riders” instead of catering to those who want “debt forgiveness” or to have the federal government force lenders to reduce their principal or interest rates.

The problem is, we will ALL be taxed to pay for government run health care. So what difference does it make?Health Care's price tag is going nowhere but up. By design, private insurance companies will disappear, employers will drop coverage, and we will soon all be forced onto the government plan.

The democrats have been working for decades to dismantle the private health care industry. They broke it and now they want a tax payer funded centralized system. And all Pelosi can do is talk about free loaders? Rush is right, the democrat party isn’t removing free loaders; the democrat party is adding free loaders. We will all be a load our own system and it will suck.

And these people AREN'T "free riders". To be a free rider, you have to, you know, actually do some riding. What Pelosi is talking about is the possibility that some young healthy person who isn't paying for health insurance might have a catastrophic accident that would use the emergency room.

Besides, to a conservative, this isn't how you become responsible when it comes to paying for health care. Responsibility is paying for your own damn medicine and taking out catastrophic insurance against the things that would wreck you financially. We don't do that now. "Health care expenses" typically isn't a line item in the family budget. "Health insurance" is, which is supposed to largely pay for doctor's visits and emergency room stuff and prescription drug plans, whether you use that stuff in a given year or not. That's what's messed up, not any mythical "free rider" issue.

"Pelosi says it's a tax on "free riders" and Limbaugh says "This is the party that celebrates free riders.""

Both are wrong, but to differing degrees.

Pelosi is wrong, so very wrong, because the ACA, through its expansion of eligibility for Medicaid, and through its subsidies for coverage through the exchanges up to 400% of the federal poverty level creates far more "free-riders" than it solves through the imposition of Roberts' tax. Her's is the lie an Obama voter will accept because it gives them a plausible reason for feeling good about this looming disaster.

Limbaugh is wrong, only because he mis-characterizes the Democrats. Sure, they celebrate free riders; more critically, the Demorats create free-riders.

It's one thing to sit by and cheer on social cancers consuming the wealth of productive citizens; it is quite another stimulating and working to create more such cancers consuming the wealth of productive citizens.

Pelosi can fuck off. Pelosi is a lying hag selling snake oil. She is a disgrace and an embarrassment to our nation.I buy my own health insurance.Ever since ObamaCare was shoved down our throats in the dead of night on party- line vote against the wishes of a majority of Americans, my health care costs have shot up at least 20%. fuck her.So Nancy Vi$a, tell us how the AARP and democrat insiders and lobbyists in the medical industry are lining their pockets? Do tell, Nancy dearest.

Tell us about the free riders who benefited after the passage of your craptastic and corrupt health care law.

If Obamacare is so wonderful, then government will have no problem giving every employee a raise in salary and then ending all health insurance benefits so our noble public servants can enjoy the wonderful benefits of this law.

In one sense Pelosi is right, but she excuses so many other free riders (illegals, welfare mommas and their chilluns) that it is impossible to have any respect for the mush-headed San Franciscan.

What Pelosi is right about is America has an impossible status quo where our system costs 60% more per capita than any other country. It gives the illegals and the welfare classes free cadillac care, bankrupts almost a million working class people a year that make too much money to get the free gravy. And sticks the middle class with picking up the tab for megamillionaire doctors, drugs that cost 60% more than our competitor nations, and all the free ER room care the indigent get via their private or employer provided health insurance.

Pelosi is also right that we cannot have a model where the young and healthy or the older and deliberately spending all their money so they have no assets to seize for unpaid bills - can be permitted to "opt out" of having health isurance. But suddenly get it the day they find they have cancer or come in all broken up from a car accident.

"Its all about Freedom for Freedom-Lovers!" crap breaks down unless you are willing to join the hardest of hardcore libertarian idealogues and say that society must let a stabbing victim with no money or health insurance bleed out on the curb and if we only go with "private charity" for welfare mommas and they chilluns....eventually enough will die untreated that the rest are motivated to get up and take one of all those great high-paying US jobs there for the taking.

"These free riders make health insurance for those who are taking responsibility more expensive."

Bullshit.

That's only true if you believe people have the right to shift the risk of their health care costs to everyone, including those who believe, for whatever reason, they will have no cause to insure for their own risks.

If hospitals could simply refuse to treat people who show up at the door with maladies that weren't immediately life-threatening, and who had no demonstrable ability to pay (insurance, credit card, whatever, I don't care, just some ability), then there would be no free riders.

Most of the "free rider" problem has been identified as abuse of the ER. Remove the legal barriers that prevent hospitals from acting like other businesses, and you have no problem. The problem is a creation of government force, to begin with.

Of course, hospitals could offer charitable care if they choose, and charities could offer to pay for hospital care if they choose, but a charity case is not a "free rider". Also, charities tend to be pretty good at ferreting out whom to help with their limited resources.

"Okay. Hell's bells. Whatever. But if this is one instance of holding people responsible — something you support — why not be pleased about it?"

Because it isn't something to be pleased about. Forcing young healthy people to pay for older people's health care doesn't please me. Holman Jenkins had a good column over the weekend on healthcare, suggested reading.

"..., then government will have no problem giving every employee a raise in salary and then ending all health insurance benefits..."

Why a raise?

All coverage in the exchanges will be subsidized up to 400% of the federal poverty level. That's $92,200 per year (for 2012 anyway - it will go up next year, and up again the year after that, and the year after that...) for a family of four.

The true "free riders" are the ones getting all the government handouts. What Pelosi is referring to are the people who make too much money to qualify for government handouts and who don't buy health insurance for themselves. If they suddenly have a catastrophic medical expense, they're liable for it or may have to file bankrupsy. If they buy insurance, they're spreading the load for everyone else.

A young, healthy person doesn't normally use much health care. Their insurance premiums are many times their medical expenses. By contrast, those with chronic medical conditions (especially in group coverage) typically pay only a small percentage of their medical expenses. In effect, the healthy people are subsidizing the sick. Likewise, women as a group use a lot more health care than men but in some states (such as Colorado) and I think in ObamaCare, it's illegal to charge women more for health insurace. This means men are subsidizing the health care for women.

During my twenties I was a free rider. I had robust health and not much else. When I was a student or working at some crappy job that had no benefits, it never occured to me to buy health insurance. I suppose some of the time I might have been eligible for Medicaid, but it never occured to me to apply for that either. There you have it. The young and healthy have now become free riders. Let's tax their good health.

As long as illegal aliens can find work any abled bodied adult on 'benefits' is a free rider. Thanks Pelosi!. Now the next congress can severely curtail the free rider problem. Problem for the democrats is once you eliminate most of the free riders, whats left of the democratic party constituency?

The penalty is on people who have the wherewithal but refuse to buy health insurance

The penalty is on the working poor, the middle class, the young, the newly unemployed. Any poor person who pays taxes and can't afford health insurance will see his or her taxes increase. She is trying to demogogue this group. But there are millions of voters who fit into this group and she is telling them, "you are a bad person and your taxes need to go up." We'll see how that flies.

Also, under this "plan," these people still will have no health insurance.

Here's what happens when you don't have health insurance. You don't go to the hospital until you are desperate. When you're desperate you go to an emergency room. They take you in and bill you. You can't pay the bills. They come after you for non-payment. You declare bankruptcy. Your credit is shot to hell.

There is no "free rider" aspect to any of this. It's idiotic. And this is the class of people she wants to raise taxes on? And after she raises taxes on them, what do these people get in return? Nothing.

No free health care, no health insurance, nothing. It's like Obama killed Santa Claus and now he's trying to run as Scrooge.

All of the 1% put together only have enough money good for a week or two to run DC's free money machine.

The middle class workers have enough if the promised benefits are withheld by Regulations. They can be made into eternal serfs to the Government and also pay for their chains, their slave overseers in DC and the Death Panels' Hawaiian vacations.

The democrat party gets a lot of mileage using their vilification machine.

You lazy free riders. Government knows best.

The reason health care costs so much? The democrat party has been hard at work destroying it from within for decades. ObamaCare is the BFD drop of nitroglycerin in progressive apparatus that will fast-track our decent into socialism. But don't call it socialism. Call it something else or the media will whine.

I think the best ads the GOP can run is just showing those clips of Obama in the primaries devastating Obamacare in advance. He was good then. Just show it, and ask "So what's he telling you now? Do you believe him?

They could make a bunch of ads like that on virtually any issue. An entire negative ad campaign in his own words. He was the most dishonest candidate in my lifetime. Suckers.

slarrow - "Besides, to a conservative, this isn't how you become responsible when it comes to paying for health care. Responsibility is paying for your own damn medicine and taking out catastrophic insurance against the things that would wreck you financially. We don't do that now."

----------------The problem is the US medical system was well and properly fucked even before Obamacare and the insurers and Hero Healthcare Providers and Noble Life-saving drug companies have all collaborated together, and with government added into the mix - to thoroughly screw clueless Freedom Lovers with any assets.You can't simply go back to the Good Old 1930s and pay your own money and give up on that Freedom-destroying insurance.

In the 90s, I learned to my shock that the struggling startup I joined in Cali had taken the cheapest HMO imaginable and that I then found out the hard way through gaps in coverage that the Hero Healthcare Providers and Hero Drug Manufacturers charged 4 times as much for pills and med services to the uninsured with assets.

You see, the scam is that the noble government and noble health insurers ostensibly negotiate huge steep phony discounts in medical care and drug prices - 25% of what the "ininsured, not covered by the helpful government programs" pay.

You have to fix that before you can even think of paying your own way. The system is rigged that stupid Freedom Lovers that do not have health isurance will pay 4 times more for a prescription drug, 3 times more for a hospital bed, up to 6 times more for ER services.

The problem with calling them free riders is that it's not clear that they actually ride free. If you limit it to people who "have the wherewithal" to buy health insurance, but don't, what percentage of that group actually free-ride? And as a practical matter, how? If they try to buy insurance after they get sick, after all, they can't get coverage for their pre-existing condition. And if they try to go in through the ER, they're still supposed to get a bill for that afterwards.

There's a lot of rhetoric about freeriding, but the actual free-riders are the poor and the chronically ill, who are free-riding precisely because they don't have the wherewithal to buy health insurance, let alone health care. The whole idea of forcing everyone to buy health insurance they didn't want was to get people who decided not to buy health insurance in order to subsidize people who can't afford the health care they want to consume. The math only works out if those so-called "free-riders" are being made to subsidize everyone else. That is the opposite of actual free-riding.

The free-riding of these purported "free-riders" is only theoretical -- they don't ride free today but they totally would once insurers have to cover all your pre-existing conditions. In other words, it's a problem almost entirely manufactured by the regulation they propose to solve the problem. It's a deeply dishonest argument.

"Because it isn't something to be pleased about. Forcing young healthy people to pay for older people's health care doesn't please me."

It's not about pleasing you. It's about making a big system work, and part of the system is required emergency care without regard to ability to pay and part of it is not excluding people with pre-existing conditions from the insurance market.

You have to make all the parts to this system function together, and you are counting on some of those parts, which will matter to you in the future.

Now you're being charged a tax, and it's a damned small price to pay -- it's not ENOUGH really -- for the right to get medical care later and the right to buy insurance after a pre-existing condition happens. Think of yourself as buying an option to buy something in the future. That's worth a lot, even if you're using none of the services yet.

I challenge you to look at all the moving parts as they operate over time and come up with an alternative that would work.

If you say, let my emerging conditions go untreated. I don't care. I'll just suffer, that's not a good enough answer, because you live in a country where other people will not live like that and will not let that happen. As a democratic majority, we decided that we didn't want that to happen to people.

You live in this democracy, with people who won't accept you lying out in the gutter rotting from cancer.

That's a part of the system that isn't going to change.

So you need to come up with a way to make the whole thing work, not merely say I don't want to spend my money on that now.

This is exactly what taxation is for, keeping people from selectively opting out of the parts of the system they don't like at the moment.

You remind me of the people who don't want to pay taxes to support the military, when they benefit from the military and will be protected by the military whether they like it or not.

This post highlighted the conservative principle of responsibility, which involves decent sophistication and acting like an adult. If you don't like the approach in Obamacare, you need to have an alternative that actually works, not the fantasy attitude that I'm young now and I'm not sick now.

Health Savings Accounts was a great solution to problem of young healthy uninsured individuals.

ACA makes those plans illegal.

What young, healthy people need is catastrophic health insurance, so they have coverage when they break their leg skiing, or fall off a rock rock climbing, or break their nose skate boarding.

Premiums are cheap for $8K deductible plans, and any remaining money can be stored in the Savings Account for future use. It's an IRA for health care. A couple of doctor free years and enough money can be accumulated to pay for any out of pocket expenses.

Unfortunately they were never marketed properly and were often confused with Flexible Spending Accounts.

The premiums for catastrophic health insurance was subsidized for the poor in the Ryan plan, I believe, with an incentive to purchase such plans.

While that would solve the 'free rider' problem, it doesn't force young folks from purchasing expensive coverage which is really just a subsidy for the rest of us.

ACA doesn't not only not address this, it makes it worse and encourages young people to just pay the tax (which does nothing to increase the insurance pool to keep premiums affordable).

The alternative to ObamaCare is to encourage a strong thriving healthy competitive private insurance industry and educate people on how important it is to have health insurance.and yes, as always, as is natural, there must be consequences to unwise and selfish decision making. The argument that "we must do this or people will die in the streets" doesn't work.ObamaCare must destroy the private market and it must force people onto a one-size fits all government plan. It must, that is the only way the moving parts work. And It must tax us all to pay for it.

Okay. Hell's bells. Whatever. But if this is one instance of holding people responsible — something you support — why not be pleased about it?

Because it's not! Government created the problem of free riders to begin with, but rather than dismantling their previous idiocy, they double down on idiocy by creating even more regulations. These idiots' whole routine is that government can solve any problem with more government, even the ones that were created due to too much government involvement.

So, what is the cost of these freeloaders that are so devastating to the system? Is it really the 42.7 billion, or more a figment of the imagination? Hospitals love to jack up the costs and then discount, thus maximizing the write-off. So, for the birth of our child we were billed - $23,000, received an insurance adjusted rate - ~6,700, of which we personally paid 1,300. So, what is the cost of care- 23,000 or 6,700?

"In 2008, for example, hospitals, physicians, and other health-care professionals received no compensation for $43 billion worth of the $116 billion in care they administered to those without insurance."

That's 43 billion out of a total of 2.5 trillion spent on health care.

The expansion of Medicaid eligibility from 100 to 133 percent of the poverty level will increase Medicaid spending by 100 billion or approximately 40 percent annually. The newly eligible Medicaid recipients account for a sizeable share of that 43 billion in unpaid bills. Do they cease to be free riders when taxpayers start paying their medical expenses?

Another share of the 43 billion is attributable to illegal immigrants. They are specifically excluded from the mandate/penalty/tax.

Drop those two classes from the 43 billion figure (out of 2.5 trillion total) and you have a minor problem which in no way justifies the loss of individual freedom inherent in the mandate.

What I can't get over is how Obamacare is designed to fail. And they've designed it to fail without regard to how much damage it will do to people.

Why do we have insurance? So that when you get sick, insurance pays for your healthcare.

Obamacare destroys this system. You don't have to buy insurance anymore. Why not? Because if you have a pre-existing condition, the insurance companies can't deny you insurance.

The whole point of health insurance is destroyed. What are you insuring against? Any future sickness.

It's like saying you can buy fire insurance after your house is burned down. It's literally insane.

So after destroying health insurance, Obama then "mandates" that everybody buy health insurance. Why, for fuck's sake? Why buy fire insurance if you can buy it after your house burns down? Only an idiot would buy fire insurance when he doesn't have to.

And yet it's a mandate. You have to buy health insurance! This useless thing that you no longer need to buy.

Oh yeah? What happens if I don't want to buy that useless thing I no longer need to buy? "Oh, no problem, you just pay a small tax to us. We realize that buying health insurance is no longer an economic benefit. So, if you choose not to buy health insurance, we will raise your taxes."

Apparently the plan is to cause as much misery and pain as possible and then we'll all be clamoring for socialized medicine.

Rush has been talking about how Obama is intentionally harming the economy. I didn't really believe it before now. But that's the only explanation for this bill.

Destroy health insurance, so that massive numbers of Americans have no health insurance.

"In 2008, for example, hospitals, physicians, and other health-care professionals received no compensation for $43 billion worth of the $116 billion in care they administered to those without insurance."

What source is Ginsburg quoting? There are too many examples of made up data making it into amicus briefs and actual SCOTUS opinions.

"In 2008, for example, hospitals, physicians, and other health-care professionals received no compensation for $43 billion worth of the $116 billion in care they administered to those without insurance."

This argument is rich considering it's MediCare's modus operandi to achieve cost "savings" by not paying the full freight.

So, for the birth of our child we were billed - $23,000, received an insurance adjusted rate - ~6,700, of which we personally paid 1,300. So, what is the cost of care- 23,000 or 6,700?

The actual cost is a little less than the $6700 they got. They would walk away from a deal that paid them less than their cost. (Except when they can't - see Medicaid) Even so-called "non-profit" hospitals make handsome enough profits to pay their CEO's millions.

The cost depends on your location (some states mandate coverage of certain services which makes insurance more costly) and your individual circumstances. I pay $330 per month for each of my employees. If I were to purchase the same policy for my family of six, it would cost my family $1700 per month.

"This post highlighted the conservative principle of responsibility, which involves decent sophistication and acting like an adult. If you don't like the approach in Obamacare, you need to have an alternative that actually works, not the fantasy attitude that I'm young now and I'm not sick now."

I'm not young and I'm not still not impressed with Pelosi's demagoguery. Young people have no way of knowing if after having been required to subsidize Obamacare that it will be there for them when they're old and need it just as they are rightfully concerned about Social Security being there for them in their old age. Again, Holman Jenkins of WSJ had a good column over the weekend.

There are a lot of free market solutions to health care that don't rely on Democratic demagoguery and big government bureaucrats that allow people to be personally responsible adults, not children.

I challenge you to look at all the moving parts as they operate over time and come up with an alternative that would work.

On the one hand, if we took Obamacare and dropped down the minimum coverage requirements (and the related pre-existing condition coverage requirement) significantly, I think it could work. If the "minimum" coverage really is quite basic, and allows for high copays or deductibles, then the cost of the plans required would be greatly reduced. There's other things I think we ought to do to improve access, but we can do them with or without Obamacare. Mandatory price transparency is one, for example. Encouraging physician ownership of health care institutions is another. Alternative licensing for types of medical care requiring less training is another. In the long run, I think access is a much bigger problem than payment and may help considerably on the payment side -- if we improve supply, price transparency, and underlying costs, then prices ought to decline.

On the other hand, one idea I've been batting around in my head is that people without insurance could be permitted to take out non-dischargeable spot loans from a federally subsidized medical loan company of some sort (but with limited coverage by type of procedure--maybe off the Medicare scale). So if they have a medical emergency, the payment can come from the government, but they have to pay it back over the rest of their lives. Put in some garnishment procedures, cap garnishment at ~5% of income, have the principal accrue interest at the Treasury rate + [X] bp (statutory rate of interest would be the natural rate, but it would probably be practically extortionate in most states), and give the loan first priority out of any estate.

You'll still have people paying in less than they get out, and taxpayers will be picking up the tab, but it will preserve market mechanisms and preserve individual autonomy -- if you don't want to take on the burden of having your income garnished for the rest of your life, you don't have to. I can see how this could blow up, financially (cf. federal student loans), and the incentives will all break down for people making end-of-life care decisions, but I think if you limit scope of coverage (e.g. no on-patent prescription drugs, no bleeding edge care, etc.) it could be made workable, particularly since Medicare also takes care of a huge chunk of what would be the most expensive patients. And I think there would be more leeway in how we structure it, in terms of individual liberty interests, because it would be opt-in, not mandatory.

On the gripping hand, if our problem here is just uncompensated emergency room care, I've read that it's just $40 billion/year, which is not really that much. I don't know the source for that, but other sources seem broadly consistent (including charity care). If you paid for that on the Medicaid rate and excluded charity care, it probably wouldn't even be $40B (although of course, Medicaid just changes uncompensated to undercompensated.)

AprilApple said...I want a market based system. I don't want a government run system. How hard is that? Am I selfish? I guess so.

I know which system will cost more and I know what system will be horribly inefficient. isn't it obvious? Just look at all the disastrous wait-in-line state-run systems in Canada and Europe.==============One of the great conservative misimpressions is that the evil state run Euro, Asian, and Canadian systems are horribly inefficient.The truth is the US system costs 60% more for drugs and care than our competive rivals pay. Longer lines with our rivals, yes, but longer lifespans because all access good healthcare, not 80% of the population as in the USA.

The American system is the most expensive and inefficient in the world. It was before Obamacare and still is with Obamacare, because Obamacare was not about getting efficiencies and lowered costs but extending the same overpriced and terribly inefficient system to more people(Outside 3rd world nations where it is both cheap and horribly inefficient in getting good healthcare to the masses.)

Hmm, but they are only free riders because providers are not allowed to refuse care. So as usual, the government creates the problem on one hand and then uses that as an excuse for even more predations. We won't even mention how the New Deal moved insurance from something purchased by individuals to something linked to a person's job... which leads to most of these problems.

SO now we are to accept the government controlling every single thing that happens in the health care system. We have to do this, not because it is Constitutional, and not because it is a good system with a possibility of working but because a Supreme Court Justice has the desire to please of a callow 15 year old girl and because one party is willing to pull every dirty trick imaginable to get what they want.

We also get to be treated to the spectacle of our half-witted and thuggish president running about arguing that his law is unconstitutional by proclaiming it a penalty instead of a tax... while simultaneously maintaining it is a tax in court and in law.

These people are insane! This is the sort of thing that happens when the government guts the Constitution and then each successive ruling has to pretend that the fictitious basis for the last must be maintained. Is Roberts really so big a fool that he thinks anyone will accept his ruling or anyone will ever see our institutions as legitimate again?

We lost the country during FDR's presidency and all of this is just the unwinding of the republic's post-constitutional phase. It will end in bankruptcy and despair because those are the only things that the government has the ability to create.

And one other thing it will do... if the Pubbies don't get this thing repealed they will cease to exist as a party. A lot of people are ready to swallow the shit sandwich and vote for Romney and campaign to put these feckless cretins back in power but if they do not deliver then they are worthless and the party will fracture as people seek alternatives.

So the bill wildly incentivizes free ridership -- by letting adult children get covered by their parents, by forcing insurance companies to accept people with pre-existing conditions, by mandating a standard rate for high risk patients -- and then the bills supporters scapegoat the free riders.

This is the government, remember, that subsidizes corn syrup while campaigning against its ingestion.

The constitution needs a freedom from oxymoron clause.

* * *

The flaw in Pelosi's logic is in her statement: These free riders make health insurance for those who are taking responsibility more expensive.

If forced to join up, the only way the ex-free-riders make health insurance more affordable for everyone else is by overpaying for their needs.

Which makes someone else the free rider. It is the nature of the thing.

* * *

You know what else has a lot of free riders? State services funded by lottery sales. All the people who don't buy lottery tickets are getting the benefit of government services funded by the stupid people who do.

Maybe the IRS should levy a penalty on people who don't buy a minimum number of state lottery tickets.

"Now you're being charged a tax, and it's a damned small price to pay -- it's not ENOUGH really -- for the right to get medical care later and the right to buy insurance after a pre-existing condition happens. Think of yourself as buying an option to buy something in the future. That's worth a lot, even if you're using none of the services yet."

But the tax doesn't actually go towards lower premiums and the rights/options you mention.

It goes to general revenue.

Only the coercion of some unknown and probably small number who will make an economically unsound decision will affect those rights/options.

There is an argument there, but not one strong enough to justify the intrusion on individual liberty.

Ann national defense is a core state function, otherwise the state has no purpose in being. Not unless you believe in private armies and warlords. The comparison to the military you make is false.

Medical care payment isn't a core state function. The famous social security ruling that you have no property rights to social security and that congress can modify,amend or eliminate it at any time of its choosing also applies to medicare, medicaid and the rest of the entitlement programs. There is no guarantee that a future congress won't curtail those programs so why pay for it now when you don't need it if there is no guarantee you will receive it? Part of the "savings', about $500 billion in the ACA comes from medicare reductions, something the LBJ hard core democrat voter base hasn't thought through. Of course when they feel the pain it will be well into the Romney Administration and he will get the blame from Pelosi and company.

As for access, everyone has access. The question is who pays? And for those who are being subsidized by others, to what extent. Since it appears the ACA has annual caps on what is to be spent on an individual then it isn't a stretch to see where based on average life expectancy how much health care is going to be paid for. Once you hit 60, if you have an IRA going forward you must take the required minimum distribution which is based on you living 15 years for every year you are alive going forward. So if you are 70 and need a hip replacement you are SOL.

The ACA may make more people eligible for government paid for care but it doesn't provide for more doctors or hospitals. And it doesn't guarantee the present and future doctors will accept those assignments. Then what?

The ACA is emblematic of the democrat party vote buying by cost shifting. If the issue is of such national importance then it should be reflected as a line item on the budget and subject to debate every year along with all other competing items for funding. Its called having elected officials held accountable. Private parties shouldn't be compelled to bare the costs of a public good. Also, unlike medicare, there was no broad national consensus for the ACA as expressed in both public opinion polls and votes in congress. Pelosi knew it and along with Reid when they passed this bill without popular consent, without bi-partisan support and according to her, she couldn't know what was in it until it was passed.. Contemptible legislation by contemptible legislators. This law should be repealed in its entirety and a new more modest and sensible bill should be passed with the consensus of the people and the parties.

Pelosi is wrong, the mandate is not about freeloaders. As was amply discussed in the oral argument at the Supreme Court, the purpose of the mandate is to get young, healthy adults, who on average incur about $800 annually in medical costs to spend $4800 annually on insurance. The Administration and the insurers needed more people in the pool to cover the freeloaders but it is not the freeloaders who will be paying. This was the big hole in the Commerce Clause argument, since it became evident that the mandate was forcing action by people who would not be the ones actually receiving the medical care.

The reason there's a "free rider" problem in the first place is that we're requiring insurers to cover people and their pre-existing conditions, while not permitting them to set premiums that take those pre-existing conditions into account.

The tax/mandate is one way to address the problem, although it will probably be ineffective; the only way Roberts found it to qualify as a tax is that it's so small as to be not truly coercive.

A smarter way to address the problem is to say to people that if you get in now (or when you first become eligible), you will never have to worry about risk-based premiums or pre-existing conditions. But if you don't, well then fine, we won't tax or fine you. But we will NOT make insurers insure you at the group rate, or cover your pre-existing conditions.

Simple. Non-coercive. Truly encourages personal responsibility. Then the question is, do we have the stomach to let people live with the consequences of their decision? I kinda doubt it. But if we're not prepared to permit people to live with the consequences of their decisions, then we're really not encouraging personal responsibility; we're running a nursery school.

Now you're being charged a tax, and it's a damned small price to pay -- it's not ENOUGH really -- for the right to get medical care later and the right to buy insurance after a pre-existing condition happens.

The right?

Anyway, the problem is people who have not purchased insurance and may or may not need medical treatment and may or may not pay for it are not "free riders". Unless you are now defining someone as a free rider simply for not participating in something AT ALL. Even if they are paying the taxes that subsidize the insurance premiums for other people.

Am I a freerider if I don't join the military, even though my tax dollars go toward supporting the military?Am I a freerider if I don't donate to the Wounded Warriors project, even though my tax money is helping pay for the basic medical care of the wounded military person?

The other goofy thing is the penalty will go to the government, but the hospitals and the insurance companies will be the ones who are out the money if people do buy insurance if they have an expensive pre-existing condition or do skip out on paying their bills. It may be a penalty, but it's doing nothing to help the people who are being ridden.

"Think of yourself as buying an option to buy something in the future."

You know, this is what insurance already IS. Or was, until they they started fucking with it.

Really, one simple law. Eliminate the role of the employer in providing health insurance (in the vernacular, make insurance "portable"), and make it unlawful to drop coverage of a covered person who develops disease, pretty much fixes the "existing condition" problem.

Then the question is, do we have the stomach to let people live with the consequences of their decision?

You are correct. It's ACA or letting people die in the streets. I'm with Althouse on this one. I don't want to live in an America that thinks people should be dying in the streets. I'm surprised people disagree with me.

"The ACA may make more people eligible for government paid for care but it doesn't provide for more doctors or hospitals. And it doesn't guarantee the present and future doctors will accept those assignments. Then what?"

"But if this is one instance of holding people responsible — something you support — why not be pleased about it?"

Because this is not such an instance.

It won't hold free-riders responsible because the worst of the actual free-rider behavior is subsidized by the state, rather than penalized.

It won't collect money for future expenses because the tax goes to the government, not to insurance companies or health-care providers.

It won't allow innovation because it imposes new taxes or regulations on things it deems unnecessary or overly profitable.

It won't simplify anyone's life because it imposes a thicket of regulations which make everything more complex, more confusing, and less predictable for everyone involved.

Aside from that, it's fantastic.

ObamaCare will fail for the same reason the NHS has failed: Because it's a badly designed and badly implemented exercise in command-and-control. If you're a realist, appealing to what the American people will or won't allow to happen to sick people, then you must also be a realist when it comes to plans such as these. Such systems never work for long, and as they fail they drive out actual workable alternatives.

The beauty of the free market system is that given most of us are not that "sophisticated", or the so called "the best and brightest" is we don't have to be because the free market system is the collective wisdom of all of those people who participate in it and I'll put my trust in the free market system over Nancy Pelosi and other Democratic demagogues.

The primary reason I visit political and opinion blogs is to help order my thoughts on subjects and events I taken the time to become informed about, have given some thought to what I've learned, and have then formed my own opinions about the matter. What helps order my thoughts is reading clear and logical prose from someone else who has also obviously given the subject matter a bit of thought and is not spewing talking points, but elucidating a principled position.

You are correct. It's ACA or letting people die in the streets. I'm with Althouse on this one. I don't want to live in an America that thinks people should be dying in the streets. I'm surprised people disagree with me.

"Dying in the streets" -- that's a particularly empty bit of cant there.

1. Even the best health care does not make you immortal. Everyone dies.

2. No public health system is going to provide the best possible health care for everyone -- that would take all the money.

3. No matter what system we implement, there are going to be some people who could have had better outcomes or could have lived longer if we'd spent a couple million dollars more. The additional healthcare purchaseable by an incremental dollar is never going to fall to zero.

All systems will leave some people "dying in the streets," as you put it. Obamacare is no different.

"I'll just suffer, that's not a good enough answer, because you live in a country where other people will not live like that and will not let that happen. As a democratic majority, we decided that we didn't want that to happen to people."

Except, that's not true.

The ACA was rammed through on all kinds of congressional rule violations, against popular opinion, for which the Democrats then lost the majority in the next election.

And, the ACA remains unpopular with the people, so this facile notion that "we didn't want that to happen to people" is just wrong.

You remind me of the people who don't want to pay taxes to support the military, when they benefit from the military and will be protected by the military whether they like it or not.

That would be an effective criticism if we paid taxes and the government provided health care to all of us.

Obamacare, of course, is something quite different. It's destroyed the incentive to buy health insurance. Which means private health insurance will get more and more expensive, with more and more employers refusing to buy it for their employees. Leaving more and more of us with no health insurance at all.

Does it not concern you, Ann Althouse, that Obama has consistently been lying about this? "If you like your plan, you can keep your plan." What a fucking liar.

He's raining down pain on the uninsured (taxes!) and simultaneously driving more and more people into that category. And in return for all this money that flows into Washington D.C., what do we get? Nothing. Massive health bills and bankruptcy.

Andy R. said...I don't want to live in an America that thinks people should be dying in the streets. I'm surprised people disagree with me.

You know, you're like someone's kid walking into the living room banging a spoon on a pot when visiting. Meaningless 'look at me, look at me' cacophony. You notice but it's easy enough to dismiss him out of hand.

Mitch McConnell: Covering 30 million uninsured is `not the issue’Mitch McConnell’s appearance today on Fox News Sunday was remarkably revealing — it showed as clearly as you could want that the Supreme Court decision is finally forcing Republicans to declare what, exactly, they would replace Obamacare with if they realize their goal of repealing it entirely.

Pressed by Chris Wallace to say what he would do to insure the 30 million people who will get insurance under Obamacare, McConnell at first dodged the question, instead launching into a litany of complaints about the law. He repeated the debunked claim that it would cut $500 billion from Medicare. Asked the question again by Wallace, McConnell actually laughed, and said he’d “get to it in a minute,” before claiming the best thing we can do for the health system overall is to get rid of the law and all of its “cuts” to health providers. He labeled Obamacare a “monstrosity” and vowed that there would not be a “2,700 page” Republican reform bill.

Asked a third time how Republicans would insure those 30 million people, McConnell said: “That is not the issue. The question is how you can go step by step to improve the American health care system.”

It's nice to see the Republicans have abandoned their "repeal and replace" fraud. Now it's just repeal. Do any of the commenters here have an alternative to the ACA?

As Althouse said, "I challenge you to look at all the moving parts as they operate over time and come up with an alternative that would work."

To be fair, Medicaid as constructed based on the dated assumption that poor, working-age men and women of sound body were adults who ought to be able to fend for themselves. So the set of people covered by Medicaid didn't map exactly to The Poor. Obamacare changes that so it's just people under 133% of the poverty level.

Longer lines with our rivals, yes, but longer lifespans because all access good healthcare, not 80% of the population as in the USA.

Sorry, longer lines do NOT equal longer life span. Especially when the statistics surrounding those claims are bogus.

Wait-in-line health care is a disaster. The only reason our health care is so costly is because, as I've stated numerous times, the democrat party has been systematically destroying the private market for decades.

Rush has got it fundamentally wrong. Liberals (aka Communists) don't want to promote free-riding. The USSR was not a slacker haven. Commies promote hard work for the benefit of the State, rather than for one's own benefit. The State then decides the appropriate goods and services to distribute. The consequences for free-riding are severe.

Ann, I agree with your post that we need to come up with an integrated alternative approach that will fix all the broken parts, but in order to do that, the adults in the room (are there any?) need to get together and review the history of the system to see what caused the problems in the first place and then fix THAT. The ACA is a bandaid approach to cancer.Costs started going up when the Feds told employers that health insurance as a perq for employees would be tax exempt. AND when Medicare and medicaid at about the same time insured that lots and lots of money would be flooding in to pay bills that were no longer being examined by the recipients of the care, so no one knew where all the money was going. NOW we have so much money coming in to all these "nonprofit" clinics that they are building palaces and putting Dale Chihuly glass sculptures in the lobby, but somehow we don't have enough money to cover care for those who really need it. A new wedge for more Federal money flowing into the system is NOT going to solve this problem...

Ann, I agree with your post that we need to come up with an integrated alternative approach that will fix all the broken parts, but in order to do that, the adults in the room (are there any?) need to get together and review the history of the system to see what caused the problems in the first place and then fix THAT. The ACA is a bandaid approach to cancer.Costs started going up when the Feds told employers that health insurance as a perq for employees would be tax exempt. AND when Medicare and medicaid at about the same time insured that lots and lots of money would be flooding in to pay bills that were no longer being examined by the recipients of the care, so no one knew where all the money was going. NOW we have so much money coming in to all these "nonprofit" clinics that they are building palaces and putting Dale Chihuly glass sculptures in the lobby, but somehow we don't have enough money to cover care for those who really need it. A new wedge for more Federal money flowing into the system is NOT going to solve this problem...

I think you should roll your second paragraph right into the first; it makes it clearer how many contingencies she's actually hiding:

"What Pelosi is talking about is the possibility that some young healthy person who isn't paying for health insurance might have a catastrophic accident that would use the emergency room and then not pay for it".

"I don't want to live in an America that thinks people should be dying in the streets. I'm surprised people disagree with me."

Apparently the question of how many people die from lack of insurance is contested. This article has information on studies that claim it could be either 45,000 or as low as 18,000 (the 2002 study).

Are commenters here arguing that people aren't dying because of a lack of health insurance? Does health insurance not provide any health benefits? Is it purely about saving people money? Or are people annoyed with my comment because the people dying are more likely in their houses and not literally on the street?

That is only true for heritable traits among those who are reproducing, and only in the simplest model of fitness. More sophisticated models of fitness acknowledge a strong benefit for variability in phenotypes, which lends adaptability to the species in the face of changing circumstances.

"The American system is the most expensive and inefficient in the world. It was before Obamacare and still is with Obamacare, because Obamacare was not about getting efficiencies and lowered costs but extending the same overpriced and terribly inefficient system to more people"

The American system was efficient in the 1950s and even in the 1990s it wasn't bad. Part of the problem is the illusion of fairness. The Canadians had a good system that was cheaper than ours but, in the 1980s, they decided to force everyone into a government plan that was never going to be fully funded. Thousands of doctors left after they were punished by the government for objecting. Private care was banned. Well, of course those who could afford it just drove to Spokane or Minneapolis or Dartmouth.

The downfall of the US system really began with LBJ and Medicare and Medicaid. We had a fine system of big public hospitals in cities like Boston and Los Angeles and New York. Medicaid excluded these hospitals from payment. Medicaid was supposed to be for "private" care. The result was that some doctors I knew quickly opened MediCal (in California) mills to profit from the Medicaid program. The county hospital which could have vastly upgraded its care for the poor, was left poorer than before. Then came the flood of illegals. I can remember when I was a resident in the early 70s having women come to the GYN clinic for a second opinion. They had been advised to have a hysterectomy by some GP and were a bit suspicious. If we told them the surgery was Ok, they would say, "We trust you boys at the County but if I go to Sunset hospital (or some other chicken coop) I can have a semi-private room." And off they would go.

The care of the middle class was good but the costs kept climbing because too much routine care was being included. I remember pediatricians agitating at the CMA convention to have insurance for well baby care. They wanted it because they were having trouble competing with HMOs. Now, they are screwed and it is their own fault. When my youngest son was born in 1969, the hospital bill for mother and baby was less than $300. It was not covered by insurance. By 1980, when my middle daughter was born, the bill was over $6,000. Insurance paid it. No coincidence.

If we are to replace Obamacare, we must get back to a viable system. It could be indemnity style insurance, like we had in the 60s. Better would be a combination of indemnity style and the ability to negotiate prices, which you cannot do now. France has that and it works pretty well. The French social safety net is dying because of the rest of the economy, not the health system. Obamacare is a system to reward every rent seeker in the health business. It won't work except by drastic rationing, which will probably lead to a revolt by patients. By that time the private system we had will be gone beyond recovery.

"A report by the House Ways and Means Committee found that 71 of the Fortune 100 companies have an incentive to drop coverage. But nobody really knows what’s going to happen. A Congressional Budget Office study this year estimated that 20 million could lose coverage under the law or perhaps 3 million could gain employer coverage. Or the number could be inside or outside the range."

Are commenters here arguing that people aren't dying because of a lack of health insurance? Does health insurance not provide any health benefits? Is it purely about saving people money? Or are people annoyed with my comment because the people dying are more likely in their houses and not literally on the street?

It's because you're engaging in dishonest intellectual base-stealing. I mean, good heavens -- you say that while defending a plan which establishes a Board, whose entire function is to cut Medicare spending and give elected officials plausible deniability when it happens.

"As a medical researcher you are certainly familiar with PCORI then, which was created as a result of the ACA."

Having a degree in outcomes research, I know that the vast majority of guidelines that will be generated by Obamacare will be "consensus guidelines" and will be worthless except as a cover for rationing.

"Moreover, there are alternatives. Despite what you’ve read, there is a coherent Republican plan. The best encapsulation of that approach is found in the National Affairs essay, “How to Replace Obamacare,” by James C. Capretta and Robert E. Moffit. (Mitt Romney has a similar plan, which he unveiled a little while ago and now keeps in a secret compartment in subsection C in the third basement of his 12-car garage)."

The annoyance stems from your slur that people don't care about the ill and the poor.

It's possible that there are people that care about the people without health insurance, they just don't want to do anything to help those people get health insurance. Mitch McConnell seems like one of those people.

I'm guessing the people without health insurance would rather have health insurance than people "care" about them, whatever exactly that means.

Then the question is, do we have the stomach to let people live with the consequences of their decision?

You are correct. It's ACA or letting people die in the streets.

Oh, yes, this country's always being compared to India or China in the 20s.

Somebody tell Hatman anybody who can afford it from all the countries with that swell government health care comes here for treatment because they get right in, the treatment is good and up-to-date, and aren't treated by somebody with Hatman's IQ.

AprilApple said...Longer lines with our rivals, yes, but longer lifespans because all access good healthcare, not 80% of the population as in the USA.

Sorry, longer lines do NOT equal longer life span. Especially when the statistics surrounding those claims are bogus.

Wait-in-line health care is a disaster. The only reason our health care is so costly is because, as I've stated numerous times, the democrat party has been systematically destroying the private market for decades.

=================Not true. The Democrat Party is NOT the "only reason" why our healthcare system was in major crisis long before any American had heard of Obama or Pelosi.

True - part of the reason for high expense and high inefficiency is that government has mandated it pick up the cost of the indigent and many other inefficiencies as paperwork and testing...

But another big problem is the "free market" ALSO failed . It failed to check exorbitant drug, doctor, for profit med services and diagnostic prices from vaulting in America far above what our competitors in Europe, Japan pay per capita. It failed because the free market failed to work to stop the salary jackups multimillion salaries for organized cabals of health services administrators, medical and nursing school "gatekeepers" making a medical education a cost 2-8 times higher than in competitor countries (what medical people say justiy their high salaries and for fee services - paying off big education loans), huge overhead costs for insurance and admin overhead.

The wonderful Free Market also permits the freedom, of Freedom- Loving trial lawyers, to go into the free market of the Courts awarding money in lawsuits and sue parts of the med system with abandon.

It has failed because Americans got into a mindset that America had unlimited wealth and that each American was entitled to "the very best, most high tech, most extensive health services" technology and the free market of healthcare goodies and services could come up with. And all they got was a system that gives them lowered life expectancy than Europe and Asia or Canada has. But which allows them to say "Amurrrrican in best in the world!! " Because of foolish rationales like how Rick Santorum's blessed baby Bella would not have gotten 4 million in medical care and would have died long ago in Sweden or Singapore.

Maybe on Fox News. But they have a completely different copy of the ACA than everyone else.-Garage Mahal

I stand corrected.

The ACA allows catastrophic plans (the max out of pocket allowed in 2014 will be $5950 for individuals, $11,900 for families).

"You’ll still be able to buy HSA-eligible policies when the health-insurance exchanges start operating in 2014. Experts are keeping a close eye on a few regulatory issues that could affect HSAs after the exchanges are running, such as whether benefits other than preventive care must be provided before you reach a policy’s deductible. Such a mandate could conflict with HSA requirements that nothing other than preventive care be exempt from the plan deductible, says Roy Ramthun, president of HSA Consulting Services in Silver Spring, Md...."

Read more: http://www.kiplinger.com/columns/ask/archive/what-health-reform-means-for-fsas-and-hsas.html#ixzz1zaPQwIzu Become a Fan of Kiplinger's on Facebook

A side note. I don't watch Fox News, so I don't know if they're claiming that or not.

The true cost of the mandate to the average person who does work and has taken responsiblity for himself by having health insurance is the higher premiums he will pay as a result of the bill....the new minimum coverages will escalate the cost to honest, hard-working folk. (i.e. The Suckers Tax)

From a while back, but this is exactly what people are not talking about. This is going to cost everybody money, not just because of the mandate, but because of all the increased requirements of the mandate. So what if i won't have to pay a co pay on whatever...how much will that increase my premium?

I dropped Dental insurance because I did the math and it was cheaper to pay out of pocket. It was impossible to recoup the extra insurance expenses. We are no longer allowed to make these kinds of judgements. We are no longer allowed to buy pure insurance, and pay some things out of pocket. This is the part of the bill that is most insane.

> It gives the illegals and the welfare classes free cadillac care, bankrupts almost a million working class people a year that make too much money to get the free gravy.

Umm, no. Elizabeth Warren's bankruptcy stats are as good as valid as her Native American heritage.

Yes, people who go bankrupt have "medical" bills. However, that doesn't imply that they went bankrupt due to medical expenses.

By and large, people who go bankrupt do so because they lost income. Most of the exceptions have gambling problems.

Yes, some sick people go bankrupt, but that's because they couldn't work. Healthcare can't fix that.

The reason that I used "medical" is that Liawatha counts substance abuse and gambling as medical problems.

see http://www.theatlantic.com/business/archive/2009/06/why-elizabeth-warrens-new-bankruptcy-study-is-so-bad/18835/ and http://www.theatlantic.com/business/archive/2010/07/considering-elizabeth-warren-the-scholar/60211/

> But another big problem is the "free market" ALSO failed . It failed to check exorbitant drug, doctor, for profit med services and diagnostic prices from vaulting in America far above what our competitors in Europe, Japan pay per capita.

Yes, they're free-riding. If we stop paying for medical innovation, who is going to?

> It failed because the free market failed to work to stop the salary jackups multimillion salaries for organized cabals

what are you babbling about?

Health care profits are a small fraction of the known medicare fraud. What makes you think that expanding govt will result in lower costs?

Edutcher - "Somebody tell Hatman anybody who can afford it from all the countries with that swell government health care comes here for treatment because they get right in, the treatment is good and up-to-date, and aren't treated by somebody with Hatman's IQ."

================The fact that people with tens of millions would prefer to travel to France or Spain to eat the priciest food there than dine on American cuisine - does not prove that France and Spain therefore have a vastly superior agriculture and food delivery system that serves the needs of their ordinary people significantly better than America's.

It's not about pleasing you. It's about making a big system work, and part of the system is required emergency care without regard to ability to pay and part of it is not excluding people with pre-existing conditions from the insurance market.

You have to make all the parts to this system function together, and you are counting on some of those parts, which will matter to you in the future.

Why do we have to make this system work? The problem is in assuming that we are stuck with this--and we must make it work!

We could get federal money out of healthcare entirely. That would let market forces and charity even things out. Have some faith in the free market system.

And stopping pissing me off with stupid shit about "making a big system work."

"If you don't like the approach in Obamacare, you need to have an alternative that actually works"

No, that's backwards. If you want to move to the ACA, you need to show how it's better than the current system. It's clearly not, and the negatives from another huge government entitlement are so obvious, you sound silly not mentioning it.

The only way you get to preferring the ACA is to ignore the benefits of the current system, and any improvements that could be made to it, and then ignoring the cost of the ACA.

What current government bureaucracy do you hope the ACA will mimic, or do you imagine some unicorn variety that never existed, actually works and saves money?

The big costs of the ACA are not in insuring the uninsured. We de facto do that now - nobody is dying in the gutter.

The big problem will be in the skyrocketing costs, and loss of innovation inherent in a government bureaucracy, as well as the exploding use of the system by people who can't resist free government cheese, just because it's there.

These costs will be enormous, and not just in dollars. Lives will be lost around the world once the profit driven innovation of the United States system is handcuffed. Money will be only a footnote to the story the costs.

Here's the thing - the folks who actually have the wherewithal to pay the ObamaTax are not the free-riders - they are the ones who, on the rate occasion when they have to visit the ER, pay cash for their visits. Because if they don't, the ER will sic a collection agency on their ass. The real "free riders" are the poor who use the ER and then don't pay and don't have any assets worth seizing. The same people who are going to either get subsidized into the government exchanges and/or get the expanded medicaid under ObamaCare. The real Free Riders, a/k/a the heart of the Democrat party.

> It failed because the free market failed to work to stop the salary jackups multimillion salaries for organized cabals<

Freeman - what are you babbling about?

---------------Let me write slooower...

Costs of doctors and bigshot hospital administrators and nurses and faculty at medical services schools, the lab test and drug monopolies - are controlled better in Europe and Asia. Salaries and fees are not set by organized cabals of hospital administrator lobbies, the AMA, Big Pharma, etc.

- I'd instigate broad and sweeping tort reform. Place a hard cap on malpractice awards after medical expenses of $200k.

- I'd ban employer provided health insurance, literally making it illegal. All health insurance purchases would be strictly between the insurance company and the individual.

- I'd allow the creation of tax free private health savings accounts. Tax payers could shunt up to 10% of their income or $20k (whichever is less). The money could be used for all small scale health costs.

"These costs will be enormous, and not just in dollars. Lives will be lost around the world once the profit driven innovation of the United States system is handcuffed. Money will be only a footnote to the story the costs."

"For example, you could say, it's great that Nancy Pelosi finally acknowledges the problem of free riders. "

What precisely is the point of doing that? Anything that Limbaugh says that is supportive of Pelosi will be run endlessly by the liberals. Meanwhile nothing Pelosi says has any value, meaning or worth. She'll say anything at any time to promote the cause and will never be held to any standard.

This is why you fell for Obama's bullshit when every conservative could see that it was nothing but bullshit.

At the risk of provoking another Althouse rant in the middle of the comments, let's look at a couple of flaws in the argument and in the law.

Pelosi's "freeloaders" don't exist. Go to the emergency room for treatment without insurance and get it for free? Not a chance. You will be billed. Following the billing, you will be hounded by bill collectors. They will write letters using law offices as return addresses and all the other "scum of the earth" tactics that bill collectors use.

The Obamacare law simply raises the level of collection efforts against the poor to "IRS mode." The feds will now hound the poor into submission.

Next Issue:

Insurance companies today base their rates on cost. Hence, old people (who use lots) pay a rate about 8 times as much as young people (who don't use much.) Obamacare says rates cannot vary by more than three to one. This is a tax on the young to pay for the old. No matter how many moving parts Althouse want to throw at this - it is a tax on the young.

Question for the philosophically inclined: do the voting habits of the young (they don't vote as frequently as the old) have anything to do with this tax?

Dude, the "we" is the people with Obama as our President and the Democrat controlled Legislature from 2009-2011.

As Instapundit points out periodically, not a lot of people feel the government has the consent of the governed.

I am not a party to this abortion. Because some nimrods elected high spending idiots to office is hardly a stain on me. I had no part of it. I almost feel the need to apologize to my children for what the government is doing to them.

The truth is the US system costs 60% more for drugs and care than our competive rivals pay.

...because, like with defense, we have to subsidize them. Drug companies have very few drugs make it to market and they spend millions on all of those failures. If they cannot make up those losses --- they will simply reduce R & D to virtually nothing. Those wonder drugs that it seems only the US is really generating? Gone.

Yeah, that's preferrable.

And if we didn't count stillborn babies and premature babies as deaths --- like the rest of the world does --- our numbers would improve remarkably.

I have to laugh, this is the democrats best spokeperson for this monstrosity, Nancy 'We have to pass it to see what's in it" Pelosi? Why Mittens isn't going after this hammer and tong is political malpratice. Repeal this turdburger before its too late.

Why Mittens isn't going after this hammer and tong is political malpratice.

Mittens had one reason why Obamacare was bad and Romneycare was good. His objection was that Obama's plan was unconstitutional, while health reform instead could be implemented at the state level in a constitutional manner. This, it appears, will no longer be a particularly compelling argument.

On a related note, it's hilarious watching the Romney campaign running around saying that the ACA is not a tax but a penalty. That should provide lots of entertainment in the coming weeks.

Not quite -- top 10% do pay something like 70% of all income taxes. But the incidence of the Obamcare tax/penalty is going to hit the middle classes more heavily than the rich because buying expensive health insurance is not really a problem for the rich. On the other hand, I think the subsidies/tax credits are coming out of general revenues so that would be rich people. On the other hand, they might come out of Medicare? -- I think Sebelius said that savings from slashing Medicare expenditures would help pay for the subsidies. So that again would be middle-class people, since Medicare is just a flat tax and there's so many more middle-class than rich.

Granted, the idiots will always be with us, but the smart people come here for care.

At least they used to.

Andy R. said...

Why Mittens isn't going after this hammer and tong is political malpratice.

Mittens had one reason why Obamacare was bad and Romneycare was good. His objection was that Obama's plan was unconstitutional, while health reform instead could be implemented at the state level in a constitutional manner. This, it appears, will no longer be a particularly compelling argument.

Romneycare was 99% MA State Legislature.

And he's sticking to the economy as his main attacking point.

Which will be a smart thing when the jobs numbers come out Friday.

Unless Hatman really believes unemployment will go down with manufacturing at its lowest in 3 years.

On a related note, it's hilarious watching the Romney campaign running around saying that the ACA is not a tax but a penalty. That should provide lots of entertainment in the coming weeks.

He's agreeing with the Conservatives on the Court, genius.

And he isn't stopping anybody from going after Choom on the proposition it's a tax.

On a related note, it's hilarious watching the Romney campaign running around saying that the ACA is not a tax but a penalty. That should provide lots of entertainment in the coming weeks.

The whole tax-penalty discussion is kind of bizarre. People are talking about it as though the government trying to manipulate you through the tax code is so much worse than the government just arrogating to itself the power to impose penalties on you however it likes. Shouldn't those be the other way around?

I can see why Democrats are stuck there. My view, for years, has been that the insistence on calling the mandate a penalty not a tax has been a function of Obama's ignorance and vanity rather than any coherent strategy or principle. There's no reason for Republicans get caught up in this debate, which may have legal significance, but is basically meaningless from a policy standpoint.

You remind me of the people who don't want to pay taxes to support the military, when they benefit from the military and will be protected by the military whether they like it or not."

My objection has nothing to do with taxes or the Constitution. I'm embarrassed to say that if the ACA was a good plan, I'd support it even if I thought the individual mandate, or it's other provisions, were unconstitutional. I oppose it because it will destroy our health care system and the people (all of us) who are dependent upon it.

garage mahal said...Wait a sec, I thought the rich paid like, 99% of all the taxes?

Do you like the mantle of ignorance or do you just wear it when it suits you? The right numbers are easily researched, have been posted on this site numerous times, and I know you're well aware of them. This is just your usual disingenuous nonsense. Or better put, just your usual lying.

Purportedly 17% of Americans are uninsured. yet the cost of uncompensated care has held steady at a bit under 3% of total medical expenses for several years. Yeah, those free riders must be the problem ... NOT.

It's a math thing. The uninsured that will have to get policies or pay the TAX are largely young healthy non-utilizers who find their income is better spent on silly things like food and rent and clothes for their kids. Because of the community ratings clause, their premiums will be much higher than they actuarially should be. IOW, they are going to be forced to subsidize the system, whether through the forced purchase of over-priced policies or through the TAX.

Just back-of-the-envelope figuring, but what it will come to is a roughly 7% immediate boost in money for the system. No increase in actual supply, of course. So overall spending will go up not down for the same amount of supply, and access will become more difficult, not less.

I have a suggestion for Nancy. If those who use the emergency room are "free riders" and must be made to pay their fair share, how about we limit the scope of ObamaCare to only emergency room visits and catastrophic care. However, nothing else is required.

In other words, insurance companies are not mandated to cover contraceptives or abortificients or routine checkups or anything else. And individuals are not mandated to purchase insurance policies that do more than that. Nor are businesses mandated to provide more than that for their employees.

bagoh20 at 1:53 PM said...No, that's backwards. If you want to move to the ACA, you need to show how it's better than the current system.

What you're jousting with is the progressive love of social engineering. They know that the status quo is not perfect (true). They also know, and I mean just KNOW - without proof or coherent defense, without the support of common sense or historical evidence - they just know that it should be fixed and how best to fix it and that their vision of how the fix will play out is what's best for you and I.

They don't need to show you how ACA is better. They just KNOW it. And you don't get a voice. You just get to open your wallet.

No tax, no taking of property, no primting of money is going to fix the tsunami of fatsos headed to the medical system. Andy R and his ilk with their self inflicted diseases are nothing to compare with the whales and fatsos who will shortly overwhelm us. Die in the street? Doubtful, since these hogs will likely not make it through the door.

But go ahead, make rhe system "fair" while these loathesome turds gorge their fat fucking faces and their children's fat fucking faces. Disaster is waddling our way

The economy is important. I understand why Mittens wants to focus on that. But there is quite possibly not a single other topic that he can bring up without harming his chances of winning the election. To his credit, he seems to realize this. It will make for a strange campaign though.

When my company has to stop offering health insurance in two years, can you make sure that my production manager's son doesn't have to wait 6 or 8 weeks for the heart surgeries that he has to receive every couple of years?

Maybe you can use your pull as a mid-level commissar in our glorious new socialist republic.

That production manager thought he was doing right by his son by working hard, by keeping a job with health insurance. We've employed him here for 20 years, and now we're going to have to drop our insurance, because it's going to become outrageously expensive. We can't ask employees to contribute more, we can't increase deductibles, and we can't afford it anymore.

Your triumphalism on this issue makes you look like a real dick-hole, garage.

B said... garage mahal said...Wait a sec, I thought the rich paid like, 99% of all the taxes? Do you like the mantle of ignorance or do you just wear it when it suits you? The right numbers are easily researched, have been posted on this site numerous times, and I know you're well aware of them. This is just your usual disingenuous nonsense. Or better put, just your usual lying.

"The economy is important. I understand why Mittens wants to focus on that. But there is quite possibly not a single other topic that he can bring up without harming his chances of winning the election. To his credit, he seems to realize this. It will make for a strange campaign though."

Pretty strange if he talks about healthcare but ignores the fact that he gave 'em the blueprint.

More seriously, it's probably like when the dumb bigots here try to make "arguments" opposed to marriage equality. At most, maybe she'll pop in to tell people they are being dumb, but there isn't anything to engage with.

More seriously, it's probably like when the dumb bigots here try to make "arguments" opposed to marriage equality. At most, maybe she'll pop in to tell people they are being dumb, but there isn't anything to engage with.

"Marriage Equality" sounds like a Sullivanistic euphemism for "Same Sex Marriage." I notice that even Althouse doesn't use the former as a tag.